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[Fifty years of subclinical primary aldosteronism: importance of early diagnosis].
[adrenal incidentaloma]
Clinical
presentation
of
excessive
aldosterone
secretion
is
often
not
specific
.
The
presence
of
resistant
severe
hypertension
(
HT
)
and
signs
of
hypokalemia
is
useful
but
inconsistent
characteristic
.
Plasma
aldosterone
level
in
primary
aldosteronism
(
PA
)
could
be
normal
,
although
inappropriately
high
for
a
low
plasma
renin
activity
and
not
suppressed
by
sodium
.
Screening
of
hypertensive
population
with
no
obvious
signs
of
PA
has
revealed
an
increased
prevalence
of
idiopathic
adrenal
hyperplasia
as
a
cause
of
aldosterone
excess
.
Nowadays
,
PA
is
the
most
common
endocrine
form
of
secondary
HT
,
with
an
estimated
prevalence
5
-
10
%
of
hypertensive
population
.
The
diagnosis
of
PA
can
lead
to
surgical
cure
in
the
case
of
aldosterone
producing
adenoma
and
unilateral
adrenal
hyperplasia
.
The
aldosterone
excess
is
responsible
for
vascular
inflammation
and
end-organ
damage
.
Left
ventricular
hypertrophy
,
cardiac
arrhythmia
and
cerebral
insult
are
frequently
seen
in
PA
and
preventable
by
mineralocorticoid
receptor
blockers
.
For
this
reason
,
screening
for
PA
in
patients
with
HT
and
hypokalemia
and
/
or
adrenal
incidentaloma
,
resistant
and
severe
HT
,
and
in
patients
with
the
onset
of
HT
at
young
age
is
advisable
.
The
most
widely
accepted
screening
for
PA
is
serum
aldosterone
to
plasma
rennin
activity
(
aldosterone
:
PRA
)
ratio
,
with
the
cut-off
of
30
ng
/
dl
:
ng
/
ml
/
h
.
Serum
aldosterone
level
could
be
included
as
an
additional
screening
parameter
.
Confirmatory
tests
are
crucial
for
the
diagnosis
of
PA
in
patients
with
an
increased
aldosterone
:
PRA
ratio
and
subtype
differentiation
for
the
choice
of
treatment
.
Diseases
Validation
Diseases presenting
"cardiac arrhythmia and cerebral insult are frequently seen in pa and preventable by mineralocorticoid receptor blockers"
symptom
adrenal incidentaloma
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